Other Points: Part 1

I didn't know what to label this article, so I just called it "Other Points" (Maybe someone can try and think of a name for it in the comments). I realised something while reading articles and talking to other colleagues at work, evidence-based psychological interventions, i.e., Cognitive Behavioural Therapy (CBT), the NHS provide, are based on research data and psychological theories representative of a demographic of individuals with similar cultural, religious, social, economic and ethnic backgrounds (Specifically, people from the white, middle-class upper class, males and the western world).  This is know as the WEIRD problem in psychology.

I even remember discussing how assessment questions and diagnostic criteria is Westernised and how this could lead to information that might not accurately represent a client's difficulties (especially individuals from or brought up with the non-Western world, beliefs and values). See Scenario 1 & 2 below to see what I mean.  

Scenario 1:   

In most non-Western cultures, respect for your elders is a massive message taught (I was), and you are taught never to interrupt or answer back anyone older than you. So, as a parent from this culture (who has raised their child with the same value), You're in an ADHD assessment, and a clinician is trying to assess whether your child is impulsive (a diagnostic criterion for ADHD). The clinician asks you the standard question, "Does your child interrupt you or talk over teachers?" or "Do they blur out answers before questions have been completed?". They then follow this up with an example of whenever you talk to your child, does he interrupt you, or when he speaks to other adults, does he? Naturally, you will say no because your child has probably learnt that behaviour and is conditioned not to interrupt when an adult is talking and has never done it in Infront of you. This may cause the clinician to think there isn't any impulsivity and not ask follow-up questions.   

But what if a different example was used. for example, does your child interrupt younger children when they talk, or their peers. The response might be different as your child may display their impulsivity in this way as its not deemed as culturally unacceptable to do this.   

Scenario 2:   

So, let's say you're a clinician conducting a child interview or observing a child at school for an Autism assessment, and you observe an ethnic minority child not providing eye contact with you or their teachers in the classroom. You might note that this is a behavioural sign of autism. However, in some non-Western cultures, especially African culture, giving direct eye contact to an elder is seen as disrespectful and rude. So, it would be essential to explore cultural upbringing with this child's family before saying that lack of eye contact is only explained by autism alone.   

The above scenarios are just a few prominent examples of why It's important to hold cultural factors at the back of your mind throughout assessment, formulation and intervention, as they can impact the formulation of a client's needs.  Now, coming back to my point about the NHS using evidence-based psychological interventions based on research data and psychological theories representative of a specific demographic of individuals. I completely get that they are evidence-based and have been shown to support various conditions. However, we wouldn’t prescribe medication for a condition where research only indicates it can help a specific demographic of individuals to every demographic with the condition. That would be unethical. To even have medication approved by the FDA, it must go through a series of drug trials, using participant from a range of different demographics. 

So, why as psychologists do, we still worship CBT and other psychological therapies? I can't answer that question, but since they are the norm, what I can do is to provide cultural adaptions to the CBT/Psychological therapies assessment and intervention (Don’t worry, I will be going into this in another article). 

Lastly,  

What your reflections on this blog?  

How do you adapt the therapeutic or diagnostic process to clients from different ethnic background? 

What should I name the blog?  

Comment your views below